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How do antibiotics help treat acute otitis media?
Antibiotics are only helpful in certain cases of AOM. In young children (under 2 years of age) and children with severe symptoms (severe or persistent pain, ear drainage, or fever over 102F) antibiotics can help reduce pain and fever within 2-3 days. In older children, or children with mild or no symptoms, AOM will often get better without antibiotics.
Treatment with antibiotics can lead to side effects such as stomach upset, diarrhea or rashes. In some cases children treated with antibiotics for ear infections end up getting severe infections with antibiotic resistant bacteria. For these reasons, doctors try to save antibiotics for those children most likely to benefit—young children and children with fever or severe ear pain. In many cases, treating with a pain medicine is more helpful than treating with an antibiotic.
Since the middle ear fluid is not infected in patients with OME, there is no advantage of treating OME with antibiotics.
What happens if my child is not treated with antibiotics?
If your child is older and his or her symptoms are mild, your doctor will offer you the “Observation Option.” Your doctor will recommend giving your child pain medicine (ibuprofen or acetaminophen) and ask you to wait a few days for the symptoms to go away. If the symptoms continue for 2 more days, your doctor would want you to call to get a prescription for an oral antibiotic. There is no long term negative impact of putting off antibiotics in children with mild symptoms.